Provider Demographics
NPI:1770703498
Name:GARDNER, THOMAS GEORGE (PT, DPT, ATC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:GEORGE
Last Name:GARDNER
Suffix:
Gender:M
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 N 47TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-6450
Mailing Address - Country:US
Mailing Address - Phone:609-947-0457
Mailing Address - Fax:
Practice Address - Street 1:1551 NW 54TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-3845
Practice Address - Country:US
Practice Address - Phone:206-368-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7655225100000X
AK1926225100000X
MA18245225100000X
WA60083661225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist